Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia

Lavinia A. Barbieri, Cesare Hassan, Riccardo Rosati, Uberto Fumagalli Romario, Loredana Correale, Alessandro Repici

Research output: Contribution to journalArticle

Abstract

Background: Peroral endoscopic esophageal myotomy (POEM) represents a less invasive alternative, as compared with conventional laparoscopic Heller myotomy for treating achalasia patients. In the last years, a number of prospective and retrospective experiences with POEM use for achalasia have been published. Methods: Relevant publications in which patients affected by achalasia underwent POEM treatment were identified by PubMed databases for the period 2010 - 2013. From each study, we extracted the number and type of major complications (defined as those requiring any additional medical or surgical intervention). Data were pooled, using random-effects models. Heterogeneity among studies was assessed by using Cochran’s Q and the l2 statistic. Results: We found 16 studies that provided data on 551 patients. The median surveillance period was 6 months (range: 3-12). The median of mean POEM duration was 156 minutes (range: 42-112). Median myotomy length was 10 cm (range: 6-14). Technical and clinical success were reported in 97% (95% CI: 94-98%) and 93% (407/428; 95% CI: 90-95%). No heterogeneity (l2 = 0%) or publication bias was present in both estimates. When limiting the analysis only to adverse events that require medical or surgical interventions, major adverse events occurred in 14% (95% CI: 11-17%); however, only one patient needed post-POEM surgery (0.2%; 95% CI: 0-0.5%). Conclusions: POEM appeared to be a highly feasible and effective endoscopic treatment for achalasia. Despite POEM being apparently associated with relatively high morbidity, most patients are successfully managed conservatively, so that POEM appears as a very safe procedure; however, POEM should only be performed in centers able to treat POEM complications, such as pneumothorax or pneumoperitoneum.

Original languageEnglish
Pages (from-to)325-334
Number of pages10
JournalUnited European Gastroenterology Journal
Volume3
Issue number4
DOIs
Publication statusPublished - 2015

Keywords

  • Achalasia
  • Adverse events
  • Complications
  • Endoscopic esphageal myotomy
  • Esophageal sphincter
  • Esophagus
  • Myotomy
  • Peristalsis
  • Review
  • Safety
  • Swallowing

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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